ArticleHSS journal : the musculoskeletal journal of Hospital for Special Surgery2025
Complications in Osteonecrosis Patients After Shoulder Arthroplasty: A Propensity-Matched Cohort Study.
Article in HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Total shoulder arthroplasty (TSA) is an effective treatment for advanced osteonecrosis (ON) of the humeral head, a condition involving vascular disruption and bone necrosis. However, systemic comorbidities in ON patients may impact postoperative outcomes. Purposes: We sought to evaluate health care utilization, systemic complications, and implant-related outcomes in TSA patients with and without ON. Methods: Using the TriNetX research database, we identified patients who underwent TSA between December 9, 2002, and December 9, 2022. Two cohorts were created: The TSA + ON cohort included patients with any ON diagnosis of the humerus within 1 year leading to their TSA, and the TSA-only cohort excluded patients with ON of the humerus within the same timeframe. Propensity score matching was used to balance comorbidities. Outcomes-including emergency department (ED) visits, readmissions, adverse events, and prosthetic complications-were assessed at 30th day, 90th day, and 1st year. The Benjamini-Hochberg method was applied to control the false discovery rate. Results: The query identified 1281 patients with ON and 71 201 patients without ON who underwent primary TSA. After matching, each group consisted of 1218 patients. There were no significant differences in ED visits or readmissions between cohorts after correction. Systemic complications were similar, except for acute kidney injury at the 90th day, which was more frequent in the TSA + ON group. No other adverse events reached significance. Implant-related outcomes, including prosthetic joint infection and revision, were comparable. Conclusion: The findings of this retrospective cohort database study suggest that TSA may be safe and effective in ON patients, with similar implant outcomes to non-ON patients. However, the increased rate of acute kidney injury we found at the 90thday in the TSA + ON cohort suggests the need for closer perioperative renal monitoring and supports individualized risk stratification to improve outcomes in this population. Level of Evidence: Level III: retrospective cohort database study.
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